|89th Annual Meeting Abstracts
What Motivates Secondary Rhinoplasty Patients?
Mark B. Constantian, MD.
St. Joseph Hospital / Southern NH Medical Center, Nashua, NH, USA.
Goals/Purpose: Secondary rhinoplasty patients are considered to be demanding, depressed, and impossible to please. Several studies indicate that body dysmorphic disorder (BDD) develops in approximately 4% of rhinoplasty patients. Why do these patients seek surgery?
The purpose of this study was to document the motivations, outcomes, and prevalence of unfavorable results in a group of secondary rhinoplasty patients.
Methods: Records were reviewed of 150 consecutive patients on whom the author had performed secondary rhinoplasty between September 2007 and December 2008. Tallied were: the patients’ expressed reasons for surgery, management issues, independent patient and surgeon satisfaction with the results, evidence of obsessive or depressive behavior, and postoperative BDD.
Results: Included were 29 men and 121 women. Mean number of prior surgeries was 2.8. The most common expressed reason for undergoing secondary rhinoplasty (41%) was the development of a new deformity (i.e., postoperative crookedness in a previously straight nose). Other motivations were: failure to obtain correction of the original deformity (33%), intolerable perceived loss of personal, familial, or ethnic characteristics (15%), desire for further improvement in an acceptable result (10%), or unrelieved airway obstruction (1%). Seventy percent of the entire group had airway obstructions. Twenty-one patients (14%) were considered to be unusually demanding and 34 patients (23%) were depressed, in line with the author’s previous data. Sixteen patients (11%) were the author’s own revisions. The author encouraged revision in 12 of these 16 patients; thus patient and surgeon agreed in 75% of cases. Five patients (3%) were unhappy postoperatively. Three patients displayed evidence of BDD postoperatively.
Conclusions: These data suggest that motivation of patients selected for secondary rhinoplasty resembles that of other aesthetic and reconstructive surgery patients: The majority (90%) sought surgery to correct deformities resulting from prior operations, to restore personal, familial, or ethnic characteristics that had been lost, or to correct functional complaints. Only 10% sought further improvements in already acceptable results.
The data do not support the conventional wisdom that secondary and tertiary rhinoplasty patients are impossible to please: 145 of 150 patients were happy with their results. Although 16 patients wanted more nasal surgery, there was a 75% overlap with patients whom the author believed needed more surgery. Twenty-three percent of patients were depressed but only three patients (2%) developed BDD postoperatively. This result compares favorably with the 4% prevalence found in the literature and in the author’s prior survey ten years ago. The improvement is believed to be due to new selection criteria: assessment of whether the nasal deformity is visible to the surgeon, can be fixed, and presents in a cooperative patient who recognizes that surgical perfection is always impossible.
Our results indicate that secondary rhinoplasty patients can undergo successful surgery in the large majority of cases. It is the author’s thesis that BDD may be misdiagnosed in many rhinoplasty patients who are only unhappy because they have sustained new deformities, or lost function, ethnic, or familial characteristics. The definition of BDD in the mental health literature may be too broad for plastic surgeons.